Hepatitis B

Let’s get straight to the issue. Why is it recommended that newborn babies be vaccinated against the hepatitis B virus (HBV) if it is a sexually transmitted disease?This is such a great question to ask and probably one of the most misunderstood policies in childhood vaccinations. We’ve provided a lot of information because this is a very important topic for parents.

Key Points:

Hepatitis B is not only transmitted sexually. It is passed from person to person in a variety of ways including bites and personal items.

There is no cure for the chronic form of the disease, which is responsible for up to 80% of all liver cancers.

Infants are much more at risk for developing chronic hepatitis B than older children and adults.

Caregivers, other children and family members may be infected and have no symptoms.

Did You Know?

The hepatitis B virus is a very tough virus and can survive outside the body at least seven days even when no visible blood is present. During that time, the virus can still cause infection if it enters the body of a person who is not vaccinated. For more information on this, click here: CDC, Pink Book

What is hepatitis B?

The hepatitis B virus is found in the blood and bodily fluids of an infected person and results in a serious liver disease. There is no cure for hepatitis B. Some of the long-term (chronic) health issues related to this virus are liver failure, cirrhosis and liver cancer. These long-term health problems are directly related to when a person is first infected.

Is hepatitis B transmitted sexually?

Absolutely! But, it is not only transmitted sexually, which is what people tend to think. In addition, the population that people often associate with hep B is IV drug users; but this, too, is a misconception.

The virus passes from one individual to the other through various bodily fluids, including blood, semen, vaginal fluids and saliva. Normal baby behavior, picking up contaminated objects off the floor, making toddlers angry who might bite, and the birth process itself put infants at risk for getting hepatitis B. Parents aren’t required to tell you if their child has hepatitis B, if they even know. (For more information, read the Kids Infect Kids story below.)

Did You Know?

Half of all parents do not know how their child acquired hepatitis B.

How Does It Spread?

Ways in which the hepatitis B virus can spread and why it is recommended to vaccinate at such a young age include:

A baby can get the virus from the mother during childbirth if the mother is infected and unaware

Blood transfusions

Bites (human)

Sharing toothbrushes or razor blades

Contact with blood in health care settings

Had direct contact with the blood of an infected person by touching an open wound or being accidentally stuck with a contaminated needle

Received a tattoo or acupuncture with contaminated instruments

Shared needles during drug use

Acute and Chronic Hepatitis B

“When a person is first infected with the hepatitis B virus, this is called an acute infection. A person may not have any symptoms or s/he could become seriously ill. Most adults will recover and get rid of the virus without any problems. If the virus remains in the blood for more than six months, then a person is diagnosed as having a chronic infection.” –Hepatitis B Foundation

The age of a child at the time of infection is a key factor in whether or not a hepatitis B infection becomes the chronic form of the illness. Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections:

80–90% of infants infected during the first year of life develop chronic infections

30–50% of children infected before the age of 6 years develop chronic infections

But why is vaccination recommended so quickly after birth?

We’ve already mentioned that a mother can be hepatitis B positive and not know it because she has no symptoms. The hepatitis B vaccine can protect the infant against the infection if given within 24 hours of exposure to the virus.

Your newborn infant, even if delivered at home, will come into contact with many people and foreign objects after their birth. The virus can be present on these people and these objects and you can’t see it and won’t know it. Acquiring hepatitis B in the first few months of life comes with a high probability that your child will have hepatitis B the rest of his or her life.

Why not just screen pregnant women for hepatitis B?

People assume that mothers would know if they were infected. Unfortunately, this is not the case. Some people (up to 7 out of 10) who have chronic hepatitis B may have few or no symptoms and not appear to be ill and so may not know they are infected. However, they can still spread the virus to other people.

Medical errors are not uncommon in the screening process because reading HBV test results is very difficult and confusing. Missed HPV diagnosis is especially common in Asian-Americans who have a higher rate of HPV infection.

“While OBGYNs suggest the mother be tested prior to delivery, there are many instances when this does not occur, or when it is possible that the mother contracts the disease in the period after testing, but before birth. Properly identifying infected mothers is complicated since there can be errors in test ordering, result interpretation or even test inaccuracy. Therefore, administering the first dose of the hepatitis B vaccine soon after birth minimizes the risk for infection from the mother or from other infected persons who may be living in the household. Additionally, the hepatitis B vaccine can actually help prevent infection in infants who are born from mothers with the virus in their blood.” –Shot of Prevention, Christine Vara

The Vaccine

Some mild problems have been reported such as soreness at the site of the shot (1 person in 4) and a temperature of 99.9°F or higher (up to about 1 person in 15). Severe problems are extremely rare. Severe allergic reactions are believed to occur about once in 1.1 million doses.

Remember, a vaccine, like any medicine, can cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely small. More than 100 million people in the United States have been vaccinated with hepatitis B vaccine. –CDC, Hepatitis B

“The vaccine has an excellent record of safety and effectiveness. Since 1982, over 1 billion doses of hepatitis B vaccine have been used worldwide. In many countries, where 8–15% of children used to become chronically infected with the hepatitis B virus, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.” –WHO, 2013

The Good News

Hep B infection rates have gone down by about 82% since 1990 when routine Hepatitis B vaccination of children was implemented and has dramatically decreased the rates of the disease in the United States, particularly among children. –CDC

Common Misconceptions about hepatitis B and the Vaccine

Let’s look at some commonly repeated false statements.

STATEMENT:

“Hepatitis B is an adult disease, is not highly contagious, is not deadly for most who contract it, and is not in epidemic form in the US (except among high risk groups such as IV drug addicts).” – The National Vaccine Information Center’s argument against infant vaccination.

STATEMENT:

“Hepatitis B is not highly contagious.”

FACTS:

Hepatitis B is actually 100 times more likely to be acquired than HIV after exposure to infected blood. You may not know when a person or another child is infected. And the virus can survive for long periods of time outside of the body.

An estimated 200,000 people are newly infected with the virus every year. Of these 200,000 infected, 90% (mostly adults and children over the age of 6) eventually recover and clear the virus, but over 11,000 will have to be hospitalized and over 20,000 (10%) will become chronically (permanently) infected with the virus.

Globally, 1 in 12 people has chronic hepatitis B or C infection. About 1 million people die each year from chronic viral hepatitis. –US Dept. of Health and Human Services

STATEMENT:

Hepatitis B is “not deadly for most.”

FACTS:

Hepatitis B infection kills up to 4,000 Americans every year—that is more deaths than from all other childhood vaccine-preventable diseases combined. It has a 1% fatality rate. That means that if there were no vaccine, 1 in every 100 children who were infected with the disease would die. But the real problem with this statement is that it does not account for the chronic symptoms of the disease or the lifelong health complications resulting from an infection.

People, including children, with hepatitis B have 200 times greater risk of developing liver cancer.

STATEMENT:

90% of people who contract hepatitis B will clear the virus.

FACTS:

This is true, but this percentage only applies to adults. In contrast, 90% of infants under the age of 1 who contract hepatitis B will have it for their entire lives, which puts them at high risk for liver cancer, cirrhosis and other liver-related complications. Not a fun or long way to live.

STATEMENT:

The US is the only country which recommends the hepatitis B vaccine at birth.

FACTS:

According to the World Health Organization, as of July 2011, 179 countries vaccinate infants against hepatitis B as part of their recommended childhood vaccination schedules. For a short period of time, France suspended its infant vaccination recommendation. After several studies showed no correlation between multiple sclerosis and the hepatitis B vaccine, the recommendation was reinstated.

STATEMENT:

Infection is “uncommon” in childhood and adolescence.

FACTS:

Before the introduction of the hepatitis B vaccine, over 30,000 children were infected annually.

An estimated 1.25 million people are currently chronically infected with the HBV in the US, resulting in up to 4,000 deaths each year from hepatitis B liver disease. Of these chronic infections 30–40% were acquired in childhood.

Bringing It Home

When you choose not to vaccinate you take the risk that the unvaccinated children your child comes into contact with had mothers who were correctly screened for HBV, and that those children have had no contact with an HPV-infected person. We have a lot of unvaccinated children in this community. We have a lot of people that love to travel to areas where hepatitis B is very prevalent. They can contract the disease and not know.

Hep B vaccine isn’t just for teenagers. Babies need it more than anyone.

The Mom Doctor

Parents need to understand that the hepatitis B virus can be spread by infectious blood and body fluids, and not solely through sexual contact. As a parent myself, I can recall countless times that I have tended to children, both my own and others, who have suffered scrapes, cuts, nose bleeds and even bites from frustrated playmates. These are realistic opportunities for exposure. Since only 7 out of 10 infected adults show any signs or symptoms, and infected children under age 5 rarely show any symptoms at all, it is obvious how the infected population can easily, and unknowingly, be transmitting the disease to others. –Shot of Prevention.

Hepatitis B Virus: Kids Can Infect Kids

by Eric Mast, MD, MPH

Many people believe that young kids in the United States don’t become infected with the hepatitis B virus (HBV) except through perinatal transmission, when HBV-infected moms pass it to their newborn children. However, several studies have documented high rates of early childhood HBV transmission among kids born in the United States to moms who are not infected with HBV.

The data indicate that the highest risk of early childhood transmission is among kids born to moms who immigrated to the United States from countries where HBV infection is highly endemic (e.g. Southeast Asia, China), but in fact the majority of early childhood HBV infections occur among African American and white children.

It’s estimated that 33,000 kids (10 years of age and younger) born to moms who are not infected with HBV were infected each year prior to implementation of routine childhood hepatitis B vaccination. In addition, an estimated 12,000 kids born to HBV-infected moms were infected each year before implementation of immunization programs to prevent perinatal HBV infections.

In household settings, nonsexual transmission of HBV occurs primarily from child to child, and young kids are at highest risk of infection. We’re not sure exactly how transmission occurs, but frequent contact of non-intact skin or mucous membranes with blood-containing secretions—including, perhaps, saliva—are the most likely means of transmission. HBV remains infectious at mild temperatures for extended periods and can be found on and transmitted through sharing of inanimate objects such as wash towels or toothbrushes.

Without vaccination, kids do infect kids.

Dr. Mast is Chief of the Prevention Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (proposed), Centers for Disease Control and Prevention.